Menopause is the point in a woman’s life where her menstrual cycle comes to an end. Perimenopause, the transition period leading up to this point, can last for years, with many symptoms presenting themselves including irregular or erratic periods, hot flushes, mood swings, headaches, joint aches and a decreased sex drive.

Here, we’ll explore the signs of menopause and perimenopause, the causes of menopause and how it’s diagnosed and treated. For more information and support in navigating menopause and perimenopause, sign up to Carecircle and connect with fellow patients, carers and medical experts.

What is menopause?

Menopause is the stage in a woman’s life where she permanently stops having menstrual periods. Usually, this happens between the ages of 45 and 55 but it can sometimes happen earlier or later. The average menopause age is 51.

Sometimes referred to as ‘the change of life’, menopause signals the end of a woman’s ability to conceive and have children. Hormone levels drop, mature egg supply diminishes and ovulation becomes irregular before stopping altogether.

Officially, true menopause is classed as the point in time 12 months after a woman’s last period. The months and years leading up to this point are the menopausal transition or perimenopause.

What is perimenopause?

Perimenopause is the transition period before true menopause happens. Although their periods won’t have stopped altogether, women will likely experience low estrogen symptoms and low progesterone symptoms as a result of their hormone levels dropping in preparation for menopause.

While transitioning, a woman’s body will release eggs less frequently, produce less estrogen and progesterone, become less fertile and experience shorter and more irregular menstrual cycles. The perimenopause time period generally lasts between 2 and 10 years.

What are the symptoms and signs of menopause?

The menopause transition period often brings on a variety of symptoms, which can have a huge impact on your daily life. Everybody’s experience is completely different—some women may encounter no menopause symptoms at all.

The actual moment of menopause is defined as when a woman’s menstrual cycle comes to an altogether stop. The primary sign of this is when a woman has gone 12 months without a period. In the period leading up to this point, women will likely encounter a range of symptoms which are detailed in the section below.

What are the symptoms of perimenopause?

Perimenopause, the period leading up to menopause, can bring on a variety of symptoms which can affect the daily lives of many women. The usual symptoms of perimenopause include:

• Changes to your periods—your periods will usually become shorter and more irregular over time before stopping altogether.
• Changes to your mood—perimenopause and menopause can cause anxiety, low mood, mood swings, low self-esteem and difficulties with memory and concentration.
• Hot flushes and night sweats—approximately 75% of women will experience sudden feelings of feeling hot or cold in the face, neck and chest. This symptom is usually sudden but brief.
• Headaches and migraines
• Muscle aches and joint pains
• Reduced sex drive
• Vaginal dryness
• Sore breasts
• Sleeping problems
• Dry skin, eyes and mouth

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What causes menopause?

Most of the time, menopause is caused by a natural decline in your reproductive hormones. This usually happens when a woman approaches her late 30s and the ovaries produce less estrogen and progesterone. Over time, this causes a decline in fertility and eventually, the symptoms of perimenopause and menopause present themselves.

Sometimes, menopause can be caused by other factors including oophorectomy, which is a surgical procedure that removes the ovaries from a woman’s body. In this event, menopause would be immediate and symptoms would likely be severe due to the process happening abruptly, rather than over a period of months or years.

Chemotherapy and radiation therapy can also induce menopause by halting menstruation but this depends on the situation. In the case of chemotherapy, a woman’s menstrual cycle may return to normal following treatment. Meanwhile, radiation therapy will only cause menopause if it directly targets the ovaries. If it’s directed towards other parts of the body like the breast, menopause won’t be affected.

Premature menopause, which is when women experience menopause before aged 40, can be caused by genetic factors, autoimmune disease or smoking. But sometimes, the cause of premature menopause is unknown.

How do you diagnose menopause?

If you’re experiencing menopause symptoms and perimenopause symptoms and they’re affecting your day to day life, you should see your GP. They’ll be able to diagnose you based on a number of factors including your age, symptoms and the regularity of your menstrual periods. Usually, they won’t carry out any blood tests unless you’re aged 40-45 (to diagnose early menopause) or under 40 (to diagnose premature menopause).

Blood tests work by measuring the amount of follicle-stimulating hormone (FSH) in your blood. FSH readings are higher in those experiencing menopause. If you’re taking hormonal treatments (like the contraceptive pill, for example), you should not be given a blood test as these can affect your natural FSH levels.

You can also buy at-home menopause tests and perimenopause tests, which check your FSH levels in your blood or urine. However, the reliability of these tests has been challenged. This is because your FSH levels naturally fluctuate during your menstrual cycle anyway.

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What’s the treatment for menopause?

There is a variety of treatments available to help ease menopause symptoms and perimenopause symptoms. These include:

• Hormone replacement therapy (HRT) — This is a safe and effective treatment, which uses oestrogen to replace the low hormone levels in a woman’s body during perimenopause and menopause. Oestrogen can be administered via skin patches, implants, tablets or a gel or spray on the skin and usually helps to relieve symptoms including hot flushes, joint pains, vaginal dryness, mood swings and brain fog.
• Combined hormonal replacement therapy — Women with a womb (uterus) will also need to take progesterone to protect the womb lining. When both oestrogen and progesterone are given, it’s referred to as combined hormonal replacement therapy.
• Testosterone — Those suffering from low sex drive may be offered a testosterone gel or cream to improve their libido, mood and energy levels.
• Non-hormone medicines — Women may also be prescribed certain drugs for hot flushes and night sweats, antidepressants for mood symptoms and cognitive behavioural therapy (CBT) for low mood, anxiety, hot flushes and joint pain. 

For more information on menopause and perimenopause treatments, you should seek medical advice from your GP. If you’d like to connect with others experiencing the same issues and provide and receive essential support on menopause and perimenopause, sign up to Carecircle today.

Menopause FAQs

It’s natural to have questions about menopause and perimenopause. Here are the answers to some FAQs.

What are the 34 symptoms of menopause?

Although some might say there are 100 symptoms of perimenopause, it’s generally said that there are 34 symptoms of menopause. These can occur before or during menopause and include:

• Hot flushes
• Night sweats
• Irregular periods
• Changes in mood
• Decreased sex drive
• Breast tenderness
• Headaches or migraines
• Vaginal dryness
• Burning in mouth
• Changes in taste
• Tingling in the hands, feet, arms and legs
• Fatigue
• Muscle aches
• Joint pain
• Bloating
• Digestion sensitivities
• Electric shock sensations
• Itchiness
• Difficulty sleeping
• Concentration issues
• Hair loss or hair thinning
• Memory lapses
• Brittle nails
• Weight gain
• Incontinence
• Dizzy spells
• Osteoporosis
• Allergies
• Depression
• Anxiety
• Panic disorder
• Irritability
• Body odour
• Irregular heartbeat

When does menopause start?

Every woman’s experience of menopause is different. For most women, menopause starts between the ages of 45 and 55. Often, it can happen before the age of 45. In this case, it’s classed as early menopause.

Sometimes, menopause can occur before a woman turns 40, which is classed as premature menopause. This affects approximately 1% of women. In this case, hormone therapy will usually be recommended in an effort to protect the brain, heart and bones until the woman reaches the natural menopause age.

How long does menopause last?

The length of menopause depends on the individual but perimenopausal symptoms tend to last four years on average. Over time, symptoms will ease and once a woman has not had a menstrual period for 12 months, she will be considered postmenopausal. Often, symptoms can persist postmenopause with hot flushes lasting a median of 10.2 years.

Some women are more likely to experience symptoms for longer than other women, including Black women and women of average weight. Those who are white and overweight tend to experience hot flushes for a shorter period, according to research.

How to stop the hot flushes without HRT?

As well as HRT, there are a number of ways to ease the symptoms of hot flushes and night sweats. These include regular exercise, limiting caffeine and alcohol consumption, stopping smoking, eating a healthy and balanced diet and taking herbal treatments. However, we recommend speaking to a doctor or specialist before taking herbal treatments. Sometimes non-hormonal medications may also be prescribed.

Homoeopathy and aromatherapy are also sometimes recommended, although the evidence to support their effectiveness is mixed. To ease the intensity of hot flushes, you could also wear loose and light clothing, keep your bedroom cool and ventilated at night and limit stress by practising yoga and meditation.

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Menopause Resources

If you’re suffering from the effects of menopause and perimenopause, you may find the following resources and links useful:

• NHS Menopause
• Menopause Matters
• Menopause Support
• The Menopause Charity
• Menopause and Me
• British Menopause Society
• My Menopause Centre perimenopause symptom checker
• Web MD menopause age calculator

Menopause is a natural part of a woman’s ageing process, but the symptoms of menopause and perimenopause can last for years and be difficult to endure. Fortunately, there are a number of treatment options available including hormonal replacement therapy (HRT), non-hormonal medicines and lifestyle changes including regular exercise, stopping smoking and reducing your alcohol and caffeine consumption.

It’s never too late to join the conversation on menopause and perimenopause. Sign up to Carecircle and connect with others experiencing the same challenges while providing and receiving essential support.

Sources

• https://www.hopkinsmedicine.org/health/conditions-and-diseases/introduction-to-menopause
• https://www.nhs.uk/conditions/menopause/
• https://www.nia.nih.gov/health/what-menopause
• https://www.hopkinsmedicine.org/health/conditions-and-diseases/perimenopause
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• https://www.nhs.uk/conditions/early-menopause/
• https://www.mayoclinic.org/diseases-conditions/menopause/symptoms-causes/syc-20353397
• https://www.womenshealth.gov/menopause/early-or-premature-menopause
• https://www.medicalnewstoday.com/articles/what-are-the-34-symptoms-of-menopause#symptoms
• https://www.ageuk.org.uk/information-advice/health-wellbeing/mind-body/6-things-to-know-about-the-menopause/
• https://www.healthline.com/health/menopause/how-long-does-menopause-last
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• https://www.nice.org.uk/guidance/ng23/ifp/chapter/diagnosing-menopause
• https://www.medicalnewstoday.com/articles/menopause-home-tests
• https://www.webmd.com/menopause/guide/menopause-basics#091e9c5e800078f3-1-3